1 / 26

Health Care Reform Where we’ve been Where we are Where we’re going

Health Care Reform Where we’ve been Where we are Where we’re going. Medicare. Inpatient Hospital/ SNF/HHA/Hospice Services. Part A. Physician/Non- Physician Practitioner/ Ancillary Suppliers/ Outpatient Hospital Services. Prescription Drug Coverage. Part D. Part B. Part C.

cirila
Download Presentation

Health Care Reform Where we’ve been Where we are Where we’re going

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Health Care Reform Where we’ve beenWhere we are Where we’re going

  2. Medicare Inpatient Hospital/ SNF/HHA/Hospice Services PartA Physician/Non- Physician Practitioner/ Ancillary Suppliers/ Outpatient Hospital Services Prescription Drug Coverage PartD PartB PartC Medicare Advantage

  3. The U.S. Spends More on Health Care Than Other Developed Countries

  4. Costs of Doing Nothing % Median Family Income to Purchase Health Insurance 1987 2006 2016 7% 17% 34%

  5. Uninsured Numbers Continue to Grow

  6. Quality – Variations in Care

  7. Federal Government P & L (2012) (in billions)

  8. Medicare Bankrupt 2024 Options- • Reduce Benefits • Increase Taxes • Reduce Payments to Providers • Reduce Utilization

  9. QUALITY TRANSPARENCYACCOUNTABILITYINTEGRATION

  10. Who Decides What Quality Is? CMS 1972- Social Security Act Professional Standards Review Organizations (PSRO) 1982-Tax Equity and Fiscal Responsibility Act (TEFRA) PSROs become PROs 1992- Health Care Quality Improvement Initiative PROs become Quality Improvement Organizations (QIO) Focus on quality rather than cost. Each contract cycle- Revised Scope of Work or Statement of Work (SOW) 1999- Aligned data elements and inclusion/exclusion criteria with JCAHO 2003- voluntary reporting of process measures 2004- reporting tied to hospital payment 2005-Hospital Compare rolled out 2007-public reporting of risk-adjusted hospital mortality rates 2009-American Reinvestment and Recovery Act 2010-Patient Protection and Affordable Care Act

  11. What is VBP? • VBP = Value Based Purchasing • Part of the Patient Protection and Affordable Care Act (PPACA, 2010) • Final rule April 29, 2011 • Designed to reward hospitals with higher quality care • Affects only CMS Medicare payments

  12. What is VBP? (cont.) • Money comes from trimming CMS base operating DRG payments (IPPS add-on payments excluded) to hospitals • FY 2013: 1% • FY 2014: 1.25% • FY 2015: 1.5% • FY 2016: 1.75% • FY 2017: 2% • Money then given back to some hospitals based on performance

  13. The Joint Commission • IPPE • OPPE • FPPE

  14. American Recovery and Reinvestment Act (ARRA) Summary of Legislation Health Care Provisions – Care Delivery Organizations: Federal Medicaid Funding $ 90 Billion Health Insurance – Extension of COBRA for early retirees $ 25 Billion NIH Scientific Research Grants $ 10 Billion HHS Wellness and Prevention Initiatives $ 10 Billion Health Information Technology for Economic and Clinical Health Act (HITECH) $ 23 Billion

  15. Total Potential Physician Payment Impact

  16. Hospital Payments at Risk

  17. “It’s not the strongest species that survives nor the most intelligent but the most adaptable.” Darwin

More Related